 
 
Rehabilitation Guideline for Acromioclavicular Joint 
Reconstruction (including Coracoclavicular Ligament 
Reconstruction) 
  
This guideline is intended to guide clinicians through the post-operative course for acromioclavicular joint reconstruction 
(with or without coracoclavicular ligament reconstruction). This guideline is time based (dependent on tissue healing) as 
well as criterion based. Specific intervention should be based on the needs of the individual and should consider exam 
findings and clinical decision making. The timeframes for expected outcomes contained within this guideline may vary 
based on surgeon’s preference, additional procedures performed, and/or complications. If a clinician requires assistance 
in the progression of a post-operative patient, they should consult with the referring surgeon. 
  
The interventions included within this guideline are not intended to be an inclusive list. Therapeutic interventions should 
be included and modified based on the progress of the patient and under the discretion of the clinician.  
  
Considerations for the Post-operative Care in Acromioclavicular Joint Reconstruction 
Many different factors influence the post-operative acromioclavicular joint reconstruction rehabilitation outcomes, 
including possible coracoclavicular ligament reconstruction. It is recommended that clinicians collaborate closely with 
the referring physician regarding modifications in the rehabilitation course.  
 
Post-operative considerations  
If you develop a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain or any 
other symptoms you have concerns with, please contact referring physician.   
 
PHASE I: IMMEDIATE POST-OP (0-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect the surgical repair 
• Control pain and swelling 
• Protect wound healing 
• Prevent shoulder stiffness 
 
Sling/precautions 
(adjust this 
section as 
appropriate) 
• Sling 
- Wear it most of the time for the first 2 weeks. 
- Sleep with the sling on. 
- More instructions will be given at the first post-op appt. 
- Remove the sling to shower and for PT exercises. 
- For washing under the affected arm, bend forward at the waist and let the arm hang 
passively, same position at the pendulum exercise. 
• Avoid active shoulder range of motion 
• Avoid reaching behind the back 
• Avoid reaching across the body 
• Avoid passive shoulder range of motion >90 degrees in any direction 
• Avoid lifting of objects 
• Avoid supporting of body weight 
• Ice as needed for pain control 
Intervention 
Manual Therapy 
• Soft tissue mobilization as indicated 
• GH, ST joint mobilization as indicated 
• Scar mobilization once incision healed 
 
 
 
Mobility/ROM 
• Pendulum 
• Supine assisted shoulder flexion to 90 degrees 
• Supine assisted shoulder external rotation 
• Isometric shoulder internal rotation 
• Isometric shoulder external rotation 
• Elbow and forearm AROM 
• Scapular retraction 
 
Criteria to 
Progress 
• Has achieved 90 degrees of passive shoulder flexion in the plane of the scapula. 
• Has achieved 30 degrees of passive shoulder ER in the plane of the scapula. 
• Tolerating range of motion and isometrics exercises. 
 
 
PHASE II: INTERMEDIATE POST-OP (7-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect the surgical repair 
• Improve shoulder range of motion 
• Minimize muscle atrophy 
• Improve neuromuscular control 
 
Sling/precautions 
• Sling: wean out of the sling unless otherwise instructed 
• No lifting objects heavier than 1lb 
• Avoid forceful pulling/pushing 
• Avoid reaching behind your back 
Additional 
Interventions 
*Continue with 
Phase I 
interventions 
Mobility/ROM 
• Counter top slides into flexion 
• Wall walks/slides 
• Sidelying internal rotation stretch 
 
Strengthening 
• Sidelying external rotation 
• Prone row 
• Prone shoulder extension 
• Prone ‘T’ 
• Prone ‘Y’ 
• Standing scaption 
 
- Theraband Strengthening 
• Internal rotation 
• External rotation 
• Biceps curls 
• Serratus punch 
Criteria to 
Progress 
• Tolerates P/AAROM/AROM program progression. 
• Has achieved at least 140 degrees PROM flexion in the scapular plane. 
• Has achieved at least 60 degrees PROM into ER in the scapular plane. 
• Can actively flex shoulder in the scapular plane against gravity to at least 100 degrees with good 
mechanics. 
 
PHASE III: LATE POST-OP (13-18 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect the surgical repair 
• Regain full range of motion 
• Improve strength and stability 
Precautions 
• Avoid lifting objects heavier than 2-3 pounds 
 
 
• Avoid any weighted lifting overhead 
• Avoid forceful pushing/pulling 
 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions  
Manual Therapy 
• Rhythmic stabilization, proprioception, and scapulohumeral rhythm exercises performed in 
clinic 
 
Mobility/ROM 
• Hands-behind-head stretch 
• Behind the back internal rotation 
• Cross-body stretch 
 
Strengthening Progression 
• Add progressive resistance 1-5 pounds to sidelying external rotation, prone row, prone 
shoulder extension, prone T, prone Y, standing scaption 
• W’s 
• External rotation and internal rotation at 90 degrees scaption 
 
Closed Kinetic Chain Strengthening 
• Wall pushups 
Criteria to 
Progress 
• Tolerates progression of stretching/ROM/strengthening 
• Active and passive shoulder motion within functional limits in all directions 
 
PHASE IV: ADVANCED STRENGTHENING (19+ WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain full range of motion 
• Continue strengthening 
• Improve tolerance for functional activities 
• Advance sports and recreational activity (when recommended) 
Additional 
Interventions 
*Continue with 
Phase II-III 
interventions 
Closed Kinetic Chain Strengthening/Plyometrics 
• Pushup progression: progress to traditional, then to unstable surface 
• Ball on wall 
• Rebounder throws at side, progress to weighted ball 
• Wall dribbles – overhead, circles 
 
Criteria to 
Progress 
• Independent self-management of symptoms. 
• Demonstrate appropriate understanding of condition and maintenance to prevent risk of 
recurrence. 
Revised October 2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this guideline 